How is a vasectomy performed?
After your assessment, you will be lying on a table in a minor surgery room. Dr Marois proceeds to cutaneous anaesthesia with a needle-free pressure injector (MADAJET) of the scrotal skin below the level of the junction of the scrotum and the penis. We usually wait 5 to 10 minutes to allows having an optimal anaesthesia. We proceed to the disinfection with rather cold liquid.
The left deferent vas is grasped by a Chinese round clamp. We then proceed to a Chinese technique with a millimetric orifice with a Chinese pointed forceps. The channel is then pulled to be sectioned, each end is cauterized and then ligated with a soluble suture. Dr Marois does not use or leave permanent metal clips to clamp the deferent vas that remains in the scrotum that may create chronic pain.
Moreover, in order to further minimize the risk of spontaneous re-canalization, Dr Marois conducts a better isolation of the deferent canal on the abdominal side by interposing the spermatic fascia. This less common method takes a few minutes of extra work per vas (right and left). It is essential to cover the vas deferens with a layer of tissue that surrounds each channel.
Is vasectomy is a permanent male contraceptive method?
In principle, the technique is irreversible. If ever the patient wants to have children after the intervention, we can attempt a vasovasostomy, with no guarantee of success.
Are there possible complications?
Complications are uncommon, but it is possible to have bleeding, infection, swelling or pain in the scrotal area. If there is persistent inflammation or discomfort, an anti-inflammatory drug may be prescribed.
Very rarely, the vas deferens canal will reform on its own before the control spermogram (early recanalisation, i.e. the two ends of the vas deferens canal reattach and allow for the passage of spermatozoa, making the man fertile). Exceptionally, spontaneous late recanalisation after vasectomy can occur, even with sectioning, ligation and cauterisation of the vas deferens.
Are there any medical counter indications?
These are relative and rare. Uncertainty about whether or not you may want children, blood coagulation disorders, scrotal hernia and non-descended testicles are some examples. In certain patients, vasectomy is sometimes unilateral and thus only performed on one side.
Does the vasectomy impacts sexuality?
Your sexuality remains unchanged. Erections and ejaculations are unchanged. The liquid from ejaculation will no longer contain spermatozoa. You will not be able to see any difference in the ejaculate since spermatozoa represent only a small part of this liquid. The ejaculate mainly comes from the seminal vesicles (two small sacs located at the base of the prostate where the vas deferens canals originate). You will also experience no change as regards sensation.
Is anesthesia painful?
This procedure is initially done with an injector which sends anesthetic liquid through the skin at high pressure. You will feel a pinching sensation like being struck with an elastic band. After that, you will no longer feel the needle in the skin or sub-cutaneous tissue at the scrotal site.
However, anesthesia is limited to the area around the injection site.
For more effective anesthesia and a more comfortable vasectomy, a right and left spermatic block is performed. This is an infiltration of the spermatic cord that eliminates pain inside the scrotum.
In addition, the sometimes unpleasant abdominal traction of the vas deferens can be slightly felt. We need to wait 5 to 10 minutes before starting the intervention. There is a small risk of hematoma since the needle is manually steered alongside the visible veins.
An Ativan is offered to anxious patients before the vasectomy, if they are accompanied.
Can my partner be present during my vasectomy?
The partner who accompanies you may be present with you in the surgery room during your vasectomy for moral support. A protective screen is placed on the thorax which prevents to see the intervention.